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Development and Validation of a Discharge Planning Index for Achieving Home Discharge After Hospitalization for Acute Stroke Among Those Who Received Rehabilitation Services

Stineman, Margaret G. MD; Kwong, Pui L. MPH; Bates, Barbara E. MD; Kurichi, Jibby E. MPH; Ripley, Diane Cowper PhD; Xie, Dawei PhD

American Journal of Physical Medicine & Rehabilitation: March 2014 - Volume 93 - Issue 3 - p 217–230
doi: 10.1097/PHM.0b013e3182a92bfb
Original Research Articles

Objective The aim of this study was to develop an index for establishing the probability of being discharged home after hospitalization for acute stroke using information about previous living circumstances, comorbidities, hospital course, and the physical grades and cognitive stages of independence achieved.

Design This is a longitudinal observational population-based study. All 6515 persons treated for acute stroke who received rehabilitation services in 110 Veterans Affairs facilities within a 2-yr period were included.

Results There were eight independent predictors of home discharge identified, and points were assigned through logistic regression: married (2 points); location before hospitalization (extended care = 0 points, other hospital = 9 points, home = 11 points); discharge physical grade (grade I, II, or III = 0 points; grade IV or V = 3 points; grade VI or VII = 5 points); discharge cognitive stage (stage I = 0 points; stage II, III, IV, or V = 3 points; stage VI or VII = 5 points); and absence of liver disease (2 points), mechanical ventilation (3 points), nonoral feeding (2 points), and intensive care unit admission (1 point). The points were added for all present factors to calculate scores. The probabilities of home discharge ranged from 65.03% in the least likely (≤21 points) to 98.24% in the most likely group (≥27 points).

Conclusions The treatment team might apply prognostic estimates from this index in discharge planning and functional goal setting after initial physical medicine and rehabilitation assessment.

From the Center for Clinical Epidemiology and Biostatistics (MGS, PLK, JEK, DX) and Department of Physical Medicine and Rehabilitation (MGS), University of Pennsylvania, Philadelphia; Veterans Affairs Medical Center, Albany, New York (BEB); Physical Medicine and Rehabilitation, Albany Medical College, New York (BEB); VA HSR&D/RR&D Rehabilitation Outcomes Research Center, REAP North Florida/South Georgia Veterans Health System, Gainesville, Florida (DCR); and Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville (DCR).

All correspondence and requests for reprints should be addressed to: Margaret G. Stineman, MD, Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics School of Medicine, University of Pennsylvania, 904 Blockley Hall, 423 Guardian Dr, Philadelphia, PA.

Supported by grant number R01HS018540 from the Agency for Healthcare Research and Quality and by the University of Pennsylvania in Philadelphia, PA, the Samuel S. Stratton Department of Veterans Affairs Medical Center in Albany, NY, and the North Florida/South Georgia Veterans Health System (NF/SG VHS) in Gainesville, FL (resources and the use of facilities). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins